CPSS RegistrationPrivate | SPARK

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SPARK CPSS Training Registration

Welcome to the Certified Peer Specialist class presented by SPARK Peer Learning Center in collaboration with Washington State Health Care Authority. We are excited to join you on your journey to becoming a Certified Peer Specialist.

Please answer the questions on this form in order to complete your registration.

This training has been paid for by your organization. The training is 80 hours long, spread over 2 weeks. Both weeks are to be attended in person.

Location: 936 Auburn Way South, Auburn, WA, 98002 (Brugger Training Room)
Dates: 12/1/25 - 12/12/25
Time: 8am to 5pm

Please note, there may be more than 1 option for the first question on the form regarding training location. please be sure to select the training that matches your organization

Training Location Your Registering For (IMPORTANT: You must select the training linked to your organization if there is more than one option*

Legal Last Name*

Legal First Name*

Preferred Name

Preferred Pronouns

Personal E-mail (Required for Exam)*

Work E-mail (As a Backup)

Phone Number (The best one to for us to reach you at)

Address (For Exam Purposes)

Country/Region*

Address*

City*

Zip / Postal code*

Agency You Work For (If Applicable)

Job Role (If Applicable)

Are there any reasonable ADA accommodations you may require for training and/or testing?

Please read and acknowledge: All required materials will be provided by SPARK. Meals will not be provided

Please read and acknoweldge: Transportation and Lodging are the responsibility of the participant or employer

Please read and acknowledge: The personal e-mail address that you provide will be used for any future communication and shared with the testing proctor for the purpose of your written test and exit interview

Please read and acknowledge: We understand that childcare may be a barrier, but children are not allowed in the class. Please be sure to arrange childcare as needed prior to joining the class.

Please read and acknowledge: Participants must attend the entire training. Attendance is monitored and during the online portion, cameras are required to be turned on.

Please read and acknowledge: A participant may only have 30 minutes of unexcused absence, or 3 hours of authorized absence per 40 hours of the class.

Please read and acknowledge: Excused absence is reserved for unforeseen urgent situations only. Please be sure that appointments and other obligations are not booked during training hours.

Please read and acknowledge: Please let SPARK know if you need any kind of accommodation

Will you require your service animal?*

Yes

No

Please read and acknowledge: An online written exam and an exit interview will be conducted after the training by a testing proctor. Specific testing times will be scheduled during training.

Please complete this form only once. You will receive a confirmation letter within a week

If you have questions or need to contact us, please reach out to the following people:
Diana: dmccallum@wayouth.us
Matt: mpolley@wayouth.us

Thank you

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